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Prepublished online as a Blood First Edition Paper on April 17, 2003; DOI 10.1182/blood-2003-01-0223.

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Submitted January 24, 2003
Accepted April 6, 2003

Erythropoietin is a potent physiological stimulus for endothelial progenitor cell mobilization

Christopher Heeschen, Alexandra Aicher, Ralf Lehmann, Stephan Fichtlscherer, Mariuca Vasa, Carmen Urbich, Christiane Mildner-Rihm, Hans Martin, Andreas M Zeiher, and Stefanie Dimmeler*

Molecular Cardiology, Department of Internal Medicine IV, University of Frankfurt, Frankfurt, Germany
Hematology, Department of Internal Medicine III, University of Frankfurt, Frankfurt, Germany

* Corresponding author; email: dimmeler{at}em.uni-frankfurt.de.

Increasing evidence suggests that postnatal neovascularization involves the recruitment of circulating endothelial progenitor cells (EPC). Hematopoietic and endothelial cell lineages share common progenitors. Cytokines formerly thought to be specific for the hematopoietic system have only recently been shown to affect several functions in endothelial cells. Accordingly, we investigated the stimulatory potential of erythropoietin (Epo) on EPC mobilization and neovascularization. The bone marrow of Epo-treated mice showed a significant increase in number and proliferation of stem and progenitor cells as well as in colony forming units. The number of isolated EPCs and CD34+/flk-1+ precursor cells was significantly increased in spleen and peripheral blood of Epo-treated mice compared to PBS-treated mice. In in vivo models of postnatal neovascularization, Epo significantly increased inflammation- and ischemia-induced neovascularization. The physiological relevance of these findings was investigated in patients with coronary heart disease. In a multivariate regression model, serum levels of Epo and vascular endothelial growth factor were significantly associated with the number of stem and progenitor cells in the bone marrow as well as with the number and function of circulating EPC. In conclusion, the present study suggests that Epo stimulates postnatal neovascularization at least in part by enhancing EPC mobilization from the bone marrow. Epo appears to physiologically regulate EPC mobilization in patients with ischemic heart disease. Thus, Epo serum levels may help identifying patients with impaired EPC recruitment capacity.


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A. Hirata, T. Minamino, H. Asanuma, M. Fujita, M. Wakeno, M. Myoishi, O. Tsukamoto, K.-i. Okada, H. Koyama, K. Komamura, et al.
Erythropoietin Enhances Neovascularization of Ischemic Myocardium and Improves Left Ventricular Dysfunction After Myocardial Infarction in Dogs
J. Am. Coll. Cardiol., July 4, 2006; 48(1): 176 - 184.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. van der Meer and E. Lipsic
Erythropoietin: Repair of the Failing Heart
J. Am. Coll. Cardiol., July 4, 2006; 48(1): 185 - 186.
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Am. J. Physiol. Renal Physiol.Home page
D. Patschan, K. Krupincza, S. Patschan, Z. Zhang, C. Hamby, and M. S. Goligorsky
Dynamics of mobilization and homing of endothelial progenitor cells after acute renal ischemia: modulation by ischemic preconditioning
Am J Physiol Renal Physiol, July 1, 2006; 291(1): F176 - F185.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
N. Urao, M. Okigaki, H. Yamada, Y. Aadachi, K. Matsuno, A. Matsui, S. Matsunaga, K. Tateishi, T. Nomura, T. Takahashi, et al.
Erythropoietin-Mobilized Endothelial Progenitors Enhance Reendothelialization via Akt-Endothelial Nitric Oxide Synthase Activation and Prevent Neointimal Hyperplasia
Circ. Res., June 9, 2006; 98(11): 1405 - 1413.
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BloodHome page
L. Zentilin, S. Tafuro, S. Zacchigna, N. Arsic, L. Pattarini, M. Sinigaglia, and M. Giacca
Bone marrow mononuclear cells are recruited to the sites of VEGF-induced neovascularization but are not incorporated into the newly formed vessels
Blood, May 1, 2006; 107(9): 3546 - 3554.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
M. E.J. Reinders, T. J. Rabelink, and D. M. Briscoe
Angiogenesis and Endothelial Cell Repair in Renal Disease and Allograft Rejection
J. Am. Soc. Nephrol., April 1, 2006; 17(4): 932 - 942.
[Abstract] [Full Text] [PDF]


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CirculationHome page
K. Satoh, Y. Kagaya, M. Nakano, Y. Ito, J. Ohta, H. Tada, A. Karibe, N. Minegishi, N. Suzuki, M. Yamamoto, et al.
Important Role of Endogenous Erythropoietin System in Recruitment of Endothelial Progenitor Cells in Hypoxia-Induced Pulmonary Hypertension in Mice
Circulation, March 21, 2006; 113(11): 1442 - 1450.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
N. Werner and G. Nickenig
Influence of Cardiovascular Risk Factors on Endothelial Progenitor Cells: Limitations for Therapy?
Arterioscler Thromb Vasc Biol, February 1, 2006; 26(2): 257 - 266.
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Am. J. Physiol. Heart Circ. Physiol.Home page
J. Muller-Ehmsen, A. Schmidt, B. Krausgrill, R. H. G. Schwinger, and W. Bloch
Role of erythropoetin for angiogenesis and vasculogenesis: from embryonic development through adulthood
Am J Physiol Heart Circ Physiol, January 1, 2006; 290(1): H331 - H340.
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Cardiovasc ResHome page
H. Tan, X. Jiang, F. Yang, Z. Li, D. Liao, J. Trial, M. J. Magera, W. Durante, X. Yang, and H. Wang
Hyperhomocysteinemia inhibits post-injury reendothelialization in mice
Cardiovasc Res, January 1, 2006; 69(1): 253 - 262.
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J. Am. Soc. Nephrol.Home page
P Van der Meer, E Lipsic, R. Henning, K Boddeus, J van der Velden, A. Voors, D. van Veldhuisen, W. van Gilst, R. Schoemaker, J. Leemans, et al.
Heart Failure after Myocardial Infarction--Benefit beyond Hemoglobin from Erythropoietin: Erythropoietin Induces Neovascularization and Improves Cardiac Function in Rats with Heart Failure after Myocardial Infarction
J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3449 - 3454.
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J. Am. Soc. Nephrol.Home page
H. Zhang, A. Zhang, D.E. Kohan, R.D. Nelson, F.J. Gonzales, T. Yang, C. Schmidt-Lucke, L. Rossig, S. Fichtlscherer, M. Vasa, et al.
Edema and Congestive Heart Failure from Thiazolidone Insulin Sensitizers--Excess Sodium Reabsoption in the Collecting Duct: Collecting Duct-Specific Deletion of Peroxisome Proliferator-Activated Receptor {gamma} Blocks Thiazolidinedione-Induced Fluid Retention. Proc Nat Acad Sci U S A 102: 9406-9411, 2005
J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3139 - 3142.
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Cardiovasc ResHome page
J. George, E. Goldstein, A. Abashidze, D. Wexler, S. Hamed, H. Shmilovich, V. Deutsch, H. Miller, G. Keren, and A. Roth
Erythropoietin promotes endothelial progenitor cell proliferative and adhesive properties in a PI 3-kinase-dependent manner
Cardiovasc Res, November 1, 2005; 68(2): 299 - 306.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Renal Physiol.Home page
C. T. Chan, S. H. Li, and S. Verma
Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease
Am J Physiol Renal Physiol, October 1, 2005; 289(4): F679 - F684.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. van der Meer, E. Lipsic, R. H. Henning, K. Boddeus, J. van der Velden, A. A. Voors, D. J. van Veldhuisen, W. H. van Gilst, and R. G. Schoemaker
Erythropoietin Induces Neovascularization and Improves Cardiac Function in Rats With Heart Failure After Myocardial Infarction
J. Am. Coll. Cardiol., July 5, 2005; 46(1): 125 - 133.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
V. J. Dzau, M. Gnecchi, A. S. Pachori, F. Morello, and L. G. Melo
Therapeutic Potential of Endothelial Progenitor Cells in Cardiovascular Diseases
Hypertension, July 1, 2005; 46(1): 7 - 18.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. Namiuchi, Y. Kagaya, J. Ohta, N. Shiba, M. Sugi, M. Oikawa, H. Kunii, H. Yamao, N. Komatsu, M. Yui, et al.
High Serum Erythropoietin Level Is Associated With Smaller Infarct Size in Patients With Acute Myocardial Infarction Who Undergo Successful Primary Percutaneous Coronary Intervention
J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1406 - 1412.
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BloodHome page
M. Scortegagna, K. Ding, Q. Zhang, Y. Oktay, M. J. Bennett, M. Bennett, J. M. Shelton, J. A. Richardson, O. Moe, and J. A. Garcia
HIF-2{alpha} regulates murine hematopoietic development in an erythropoietin-dependent manner
Blood, April 15, 2005; 105(8): 3133 - 3140.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Andreotti and R. C. Becker
Atherothrombotic Disorders: New Insights From Hematology
Circulation, April 12, 2005; 111(14): 1855 - 1863.
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Diabetes CareHome page
P. M. Humpert, R. Neuwirth, M. J. Battista, O. Voronko, M. von Eynatten, I. Konrade, G. Rudofsky Jr, T. Wendt, A. Hamann, M. Morcos, et al.
SDF-1 Genotype Influences Insulin-Dependent Mobilization of Adult Progenitor Cells in Type 2 Diabetes
Diabetes Care, April 1, 2005; 28(4): 934 - 936.
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HypertensionHome page
F. H. Bahlmann, K. de Groot, O. Mueller, B. Hertel, H. Haller, and D. Fliser
Stimulation of Endothelial Progenitor Cells: A New Putative Therapeutic Effect of Angiotensin II Receptor Antagonists
Hypertension, April 1, 2005; 45(4): 526 - 529.
[Abstract] [Full Text] [PDF]


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NEJMHome page
G. Weiss and L. T. Goodnough
Anemia of Chronic Disease
N. Engl. J. Med., March 10, 2005; 352(10): 1011 - 1023.
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HypertensionHome page
A. Aicher, A. M. Zeiher, and S. Dimmeler
Mobilizing Endothelial Progenitor Cells
Hypertension, March 1, 2005; 45(3): 321 - 325.
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CirculationHome page
J. Grisar, D. Aletaha, C. W. Steiner, T. Kapral, S. Steiner, D. Seidinger, G. Weigel, I. Schwarzinger, W. Wolozcszuk, G. Steiner, et al.
Depletion of Endothelial Progenitor Cells in the Peripheral Blood of Patients With Rheumatoid Arthritis
Circulation, January 18, 2005; 111(2): 204 - 211.
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BloodHome page
D. J. Manalo, A. Rowan, T. Lavoie, L. Natarajan, B. D. Kelly, S. Q. Ye, J. G. N. Garcia, and G. L. Semenza
Transcriptional regulation of vascular endothelial cell responses to hypoxia by HIF-1
Blood, January 15, 2005; 105(2): 659 - 669.
[Abstract] [Full Text] [PDF]


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JAMAHome page
K. Maiese, F. Li, and Z. Z. Chong
New Avenues of Exploration for Erythropoietin
JAMA, January 5, 2005; 293(1): 90 - 95.
[Abstract] [Full Text] [PDF]



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